Abstract A previous study titled Influenza Incidence, Diagnosis, Treatment Efficacy, Vaccine Effectiveness (INFLUMI-Award: 1U01IP000791-01), which was conducted between 2013 and 2018 in Panama and El Salvador, observed the impact of respiratory virus, mainly influenza on a cohort of women (N=2565) and their children (N=1586). Thus, requiring robust epidemiologic, clinical, and laboratory surveillance systems and research infrastructure. As part of the children's evaluation, a Bayley's III test was conducted (N=1088) to determine any cognitive, psychomotor, or language impairment. The present project proposes to improve surveillance, reporting and epidemiological intelligence with further follow-up of the children cohort up to eight (8) years of age. The overarching goal of the proposed project is to further evaluate the prevalence of psychomotor, cognitive, and behavioral development problems among children in the cohort. At start of the proposed Project in November 2019, the children will be 3.5 years of age. We pretend to follow them up for four years. This will be accomplished by building-on existing partnerships and previous research; supporting the development, maintenance, and expansion of sentinel surveillance sites in Panama and El Salvador and by evaluating the effect on neurocognitive development of frequent and severe respiratory infections during pregnancy that might impact early chilhood. Processes include contact of children and re-introduction into the system during the first year. Subsequent years will include training and capacity building of influenza, influenza preparedness, and other respiratory pathogen surveillance in the Americas.